Navigating Burnout: Managing Your Own Stress While Taking Care of Others

Learning Outcomes

After this course, participants will be able to:

1. Identify the physical and emotional symptoms of burnout.
2. Distinguish if they are currently experiencing or have experienced burnout by asking themselves specific and measurable questions.
3. List manageable coping mechanisms and self-care practices to combat burnout.

Introduction

Today's presentation is navigating burnout, managing your own stress while taking care of others during a pandemic. We keep thinking the COVID pandemic is over, but instead it feels like wave after wave. Many of us allied health providers feel as though we have been running on empty for the last two years. Some of us, including me, came from a mindset of "give until you're empty and then give some more'.  It took the pandemic, when I was working seven days a week, answering every email, and taking on every new client, when I started to have the physical symptoms of burnout. I realized that I could not sustain the pace any longer. My hope is that by using my experience with burnout and running a group practice, that I can help other professionals. We are doing important work and there is no end in sight to the need for our services.

 ]I am a licensed clinical social worker. I have a master's in education, curriculum and instruction, and I have a graduate certificate in organizational and executive coaching. I am the founder of Forward In Heels, an intersectional feminist group therapy practice that empowers all women to stand tall and own their worth so they can light up the world. In my twenties, I was the classic overachiever, with multiple graduate degrees and fellowships.  I was always looking for the next gold star to make me feel valid. I was constantly making lists and plans only to have to rewrite them when something unexpected came up, as it always does. I would go to a therapist and after three sessions, they would say, well there's nothing wrong with you, which I know now was the worst thing I could have heard. I'd think, clearly I just have to work harder. Finally, I realized that I suffer from high functioning anxiety, and that just because I'm often able to sublimate my anxious tendencies into achievements doesn't mean it is not negatively impacting me.

I created a practice that recognizes that being a badass doesn't mean you never have doubt, and that being the strong one doesn't mean you never need to be checked on. Being the one everyone always goes to for solutions doesn't mean you're never vulnerable. What makes me come alive is seeing women realize the unrealized, unlimited potential in them. When women can take care of themselves personally, their light shines through, and the best version of themselves shows up professionally.

I specialize in combining cognitive behavioral therapy and psychodynamic approaches to help stressed out, overachieving women overcome imposter syndrome and dissatisfaction. As a result, women go from chasing the brass ring to achieving sustainable happiness in every aspect of their lives. This may sound similar to how many of us chase that next thing, but what we have to recognize is that the search towards self actualization is not one that we're ever going to reach.

Pre-pandemic studies showed that two in 10 US adults experienced an episode of mental illness or chronic mental illness each year. One in 10 US adults reported symptoms of anxiety or depressive disorder from January to June 2019. These statistics are from the Kaiser Family Foundation (read the issue brief here) who does ongoing reports of the state of the health in this country. During the pandemic, about four in 10 adults in the US have reported symptoms of anxiety or depressive disorder. That is an increase from about 50 million people in 2019 to just over 100 million people in 2020. No wonder therapists have waiting lists and clients seem to multiply by the day.

Think about a time when you've been in a car and you've experienced a near miss, where you and the other driver don't actually collide. Your nervous system doesn't immediately calm down. It could take minutes or hours before your heart rate stabilizes and your breathing becomes normal again. That example - a near miss car accident - is when a short term threat appears, disappears and doesn't return. Now, realize that your body and your brain on an unconscious level have been perceiving a permanent threat for over two years due to the pandemic. Think about how that situation elevates all of the emergency response systems in your body to a new baseline. When we are no longer in a pandemic, but in an endemic (meaning that this virus will be with us always but managed by vaccines and treatments like the annual flu), we will still have a long road ahead of us.  It will take a long time to change how our bodies and brains are perceiving our environments.

Fight, Flight, Freeze, Fawn, Fold 

We are familiar with "fight flight freeze", and there are some more recent add-ons like "fawn or fold".

For many of us, instead of getting stuck in one response of fight, flight, or freeze, we've been cycling through them. This may sound familiar to you or your clients: You're lethargic all day, you have trouble finding motivation to do anything because nothing really seems to matter. The work keeps piling up no matter how much you do, and the laundry always needs to get done. You feel stuck on a hamster wheel. You're stuck in freeze all day, conserving energy for some imaginary future fight. Then when it's finally time for bed, you're wide awake. Your mind is racing and you can't fall asleep no matter how many sleep hygiene strategies you use. Your brain thinks it's time to fight. When you finally do fall asleep, no matter how long you sleep, you don't wake up well rested. This is because instead of letting your brain get into deep REM sleep, your flight response is keeping you closer to the surface, just in case a threat attacks in your sleep, and you might have to jump out bed and run.

You're essentially catnapping. You know how when a cat seems asleep, but you walk by and they open one eye just to make sure you're not a threat? That's what cats are supposed to do evolutionarily, but humans are not. We are supposed to get into deep REM sleep. No wonder we're burned out. When our brains are overburdened, we can't think critically and our executive functioning is compromised. When we are in fight, flight or freeze the blood rushes from our brain to our bodies - our muscles and our heart and our lungs - in case we have to fight or run. We need to think about strategies and problem-solving when we're feeling calm. 

What is Burnout?

What is burnout? This word is everywhere, but let's dissect it. Before burnout is languishing, which is a fairly new phrase that has been created by Adam Grant. Grant is a researcher and public figure in the field of self-help, mental health, and self-care. Languishing refers to a state where you still have some level of energy and maybe some hope, but you feel joyless and aimless. It's the opposite of flourishing. It's a sense of stagnation and emptiness. When you're languishing,  you may feel like you're muddling through your days, looking at your life through a foggy windshield. The symptoms of languishing can mimic depression, but they are externally caused by your circumstances. The next step is burnout if you don't address or recognize languishing.

Burnout is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress that can leave an individual feeling helpless, disillusioned, and exhausted. As the stress continues, you begin to lose interest and the motivation that led you to take on a specific role in the first place. Many of us got into allied health professions because we care about people and we want to make the world a better place. When we feel like we are being crushed under the weight of all of our expectations, both personal and professional, we stop remembering why went into healthcare. Jobs with higher pay and fewer hours start to look really attractive when you're burned out, as does quitting altogether.

Burnout can also lead to long term problems with your body that make you more vulnerable to illnesses like colds and flu. How does burnout affect productivity and energy? It reduces productivity and zaps your energy, leaving you feeling helpless.

Other signs of burnout include:

• Anger/irritability
• Exhaustion
• Frustration
• Impatience
• Decreased ability to be flexible with unforeseen changes

Regarding anger and irritability, it may show up as something that might have bothered you only a little bit before, bothers you a lot more when you are burned out. 

Regarding exhaustion, I mentioned that when you are stressed, your body does not get the restful sleep that it needs, and is not replenished. Think of yourself like an iPhone battery. When your phone battery is depleted and you have 0% battery left, you don't expect that you will be able to continue making calls and using apps. You are the same as a battery. You cannot keep burning yourself out, going down to zero, and then expecting yourself to keep going. 

Frustration and impatience are similar to anger and irritability.  When you are frustrated, you don't have patience with yourself, let alone others, to keep doing things that are hard. Maybe you don't have the time tolerance to do anything longer than watch a TikTok video. These are all symptoms of burnout because your brain is attempting to conserve the energy that it needs to keep going for life. Your brain is really meant to keep you going for as long as possible. Burnout is like you're running a sprint, not a marathon.

Another sign of burnout is a decreased ability to be flexible with unforeseen changes. Many people had to reschedule vacations, weddings, family events, over and over again during the pandemic. Understandably at this point, people are done with it. They are sick of having to reschedule, only to have one more curveball thrown at them. They may not have the capacity for more unforeseen changes.

Burnout can look like distancing yourself from social activities, and from friends and family. If you're experiencing excitement about upcoming projects, feeling well rested after vacation or able to maintain your empathy and compassion, you're likely not experiencing burnout. However, that doesn't mean you might not be on your way there. Look at this holistically. Maybe you still have hope for some future project at work, but you find yourself starting it and then abandoning it after 20 minutes instead of an hour.  That may be a sign that you are starting to burn out. 

Burning out can also have physical symptoms like exhaustion, hair loss, and digestive issues.

Other ways that burnout can show up in yourself and others include:

• Missed deadlines
• Poor communication
• Poor conflict resolution
• Less proactive behavior
• Great Resignation
• Calling out more often
• Poorer work quality 

Missed Deadlines

Burnout shows up practically in many ways including missed deadlines, and a lack of drive. Maybe things you cared about don't seem important anymore.  You may have an important presentation at work and think, "Who cares if the slides are not perfect; millions of people are dead of COVID." Or, "Who cares if my kid's permission slip is late?"  You see dinosaurs at a museum and you think they represent a fast-approaching dystopian future. While these examples may sound dramatic, they're the kinds of things I hear over and over again from clients. And if I'm being honest, sometimes they are part of my own internal narrative. It can be frustrating as a practitioner to sit in front of someone who is saying, "What's the point of all of this?" and to recognize that you don't have a great answer.  You can't give them a simple solution because they are concerned with global issues, war, political discourse and other complex problems. That makes me feel very helpless, which as a practitioner is something that I don't often encounter because I usually have ideas and solutions for clients to try.

Poor Communication and Poor Conflict Resolution

As social workers, we have graduate degrees in human behavior. However, during these past few years, I know for me, it sometimes seems like all of my communication skills have gone out the window. I have seen some of the worst behavior in communication in Facebook groups, exclusively made up of therapists. We're all burnt out and all of those skills we spent years honing feel useless in such a time of acute layered crises. Everyone has spent the last two years in some ways alone in an echo chamber of their own thoughts. Our worlds got smaller, even if you live with people, and even if you kept working.

If you think about a day in the life previously, it included so much more social interaction. For me, I started my day getting coffee from a barista first thing in the morning, interacted with a security guard, and then with colleagues. I would come to work with a bounce in my step. During the pandemic, a lot of us were (and maybe still are) alone in a room, whether it's at home behind a computer screen or in a safe sanitized version of our old offices. Things have changed and all those intangible communications that we used to have, don't exist anymore, so everything takes on higher importance. Poor conflict resolution goes along with poor communication.

Less Proactive Behavior 

A lot of people that I've worked with have big questions. They have expressed concerns such as, "Why should I save for retirement if the financial system will collapse and there will be no social security, that I have spent my life contributing to?" They are asking why they should exercise and be healthy if they followed all the rules and still got COVID. Maybe grieving family members who "followed the rules" still died. Understandably, that can lead to less proactive behavior and more reactive behavior.

The Great Resignation

My clients seemed to have one of two experiences during the pandemic. Some were laid off or furloughed. They felt that no matter how hard they worked, how highly they performed, or how they did everything right at work over the years, external forces were at play and their efforts didn't matter. They were in the same boat as colleagues who didn't work as hard. The other experience was one. where companies had more business during the pandemic. These clients began working even harder, 24/7, to keep their companies afloat. The lines were blurred between home and work. People started working on the weekend to try and get ahead because they had nothing to do in their personal lives, but the emails kept coming and the work kept coming. At the end of the year. maybe they saved their company or had record profits, but the individual received no raise and no promotion. These clients realized that no matter how hard they worked, the promise of a reward that was commensurate with the work they put in was a mirage. Regardless of which experience clients had, they came to a the same realization: it's futile to work hard and care so much about work, because much of what happens to me is outside my control.

This led to what has been referred to as the "great resignation". People left their jobs, and some people found new jobs. Some people who were asked to return to an in-person office wanted to continue working from home, and some companies have been inflexible about that.  Some people are not leaving the workforce entirely, but leaving the strict corporate structure to do their own thing. This has been coined the "great reshuffle". You might see this in healthcare providers - many therapists have left community mental health centers, agencies, and hospitals to go into private practice. In private practice, they can organize their schedules around their families, and they realized they can do much of their work at home as they did during the pandemic. Other people are having realizations that life is short, and they are leaving their jobs for work that is more meaningful. While that could be a great thing, it is also a time of fear, uncertainty, and tumult for many od our clients.

Calling Out Sick / Cancelling 

Another thing you might see is calling out sick more often. Clients might say, I just couldn't get up. Sometimes we do that because we can plan something restful or restorative like a planned mental health day where we get in a few doctors' appointments and then maybe work in an enjoyable activity. Other times, it's a last minute panic-induced choice of opening your eyes in the morning and thinking you just can't go to work. That is when we're reaching that point of burnout.

If you find yourself canceling with clients or being grateful when a client cancels, you might want to examine if you're reaching that point of burnout.

Poorer Work Quality

In the case of burnout, poorer work quality is not the result of being lazy or not caring. For a lot of people it's because their brain is overtaxed and they just don't have it in them to keep performing at that 100% level hour after hour, day after day. It's not that they're trying to deliver poor quality work. As a social worker, maybe you are I'm so tired, overworked, and overburdened. I need to look at my schedule and see what I can control. Maybe I can shift people around or take a longer break. Maybe I just have too many clients and I have to think about that referring out or doing something differently. If you are also managing people where all of these behaviors are showing up, it might be incredibly frustrating.

New Perspective

If you are able to view these effects as the result of the trauma responses of fight flight and freeze, could it change how you approach caring for others and for yourself? What would you do if you viewed poor work quality as a trauma response? If you've ever had an employee come to you in a crisis, did you treat them differently?  If an employee disclosed a serious illness, discussed exitting a violent relationship or experienced a miscarriage, did you treat them differently while they were experiencing their crisis? Were you more understanding, more accommodating or more flexible?

What if we could take that perspective and energy and change the expectations for ourselves and the people around us? What if we zoom out and say, we need to draw the results we need from ourselves and others without criticism. We still have to get these results to our clients. We still have to design this project for our stakeholders. Both things are true- we understand that we're coming from a trauma brain and that we also still have to work towards a larger goal. What would it look like to be understanding, but not to be excusing?

Which of these symptoms have shown up for your clients in the past few years? Here are the results of the poll of attendees from the live webinar format of this course:

• 43% missed deadlines
• 57% poor communication
• 61% said poor conflict resolution
• 54% less proactive behavior
• 21% great resignation
• 25% calling out more often
• 43% poorer work quality

Self-Care Strategies 

When we go back to the basis of what makes us better or worse at conflict resolution, it often starts with how we're taking care of ourselves or how we're not. What can we do at the individual level? I care very much about immediately actionable stragegies. It's important to me to start with the why, to find out what is happening and how we notice it. The next step is what we can do about it. This is the macro level of the Cognitive Behavioral Therapy (CBT) and psychodynamic approach that we take in my practice. Self-care is more important than ever because we are living through an epidemic of anxiety and depression. Self-care allows us to better cope with daily stressors, such as trying to keep up with the pace of daily life, technology loneliness, and it includes ability to unwind.

Our bodies and our minds are intricately connected. Self-care allows us to take positive steps to tend to our physical, emotional health. The practice of self-care allows individuals, families, and communities to promote health, prevent disease, maintain health and cope with illnesses alongside the support of a healthcare provider. I am sure you have seen the research that shows time and again tne of the number one predictors of health and longevity is community.  The actionable strategies I will discuss today include: Thought Stopping, Box Breathing, Physical Grounding, Focus on What You Can Control, Wait 24 Hours, Positive Reframing, and Gratitude Practice.

Thought Stopping

I often hear a spiral that sounds like this: "Oh no, my boss scheduled a 15 minute meeting with me at the last minute with no context. That's never happened before. Obviously I royally messed up on the last assignment, and I'm costing the company money. You know what, I've bankrupted my company, I'm getting fired. I'm probably getting sued, too.

I'm sure many of us have heard a version of that from our clients or we recognize that type of thinking in ourselves. Thought stopping involves saying the word "stop" loudly and forcefully. You can also tie a rubber band around your wrist and snap it when you notice the thoughts start to spiral. Hearing the word "stop" (or feeling the snap) jars you, and stops that spiral in its tracks. At that point you're not going to actively resume the spiraling thoughts, because you've noticed that it's not working for you. You can start replacing those thoughts. Maybe you think, I did mess up on the last assignment, but I have boss to give me feedback so that I can correct it and do better for next time. Meeting for 15 minutes would probably not be long enough to tell me that I ruined everything and I'm getting fired and sued. And, I don't see Human Resources listed as an invite to the meeting. I'm probably not that powerful to bankrupt the company, anyway. The purpose of thought stopping is not to get too caught up in the story until we have actual information and evidence to know which direction to go. The purpose of replacing the thoughts is not to paint a rosy picture and tell yourself everything is amazing. The point is to pause and focus on the information you have without continuing the spiral.

Box Breathing or Four Square Breathing

Box breathing (also called four square breathing) is one of my favorite practices that I use, when I can't fall asleep, or I find that my heart is racing for whatever reason. It involves exhaling to account of four, holding your lungs empty for a four count, inhaling for a count of four, and holding air in your lungs for a count of four before exhaling and beginning the pattern anew.

This simple technique forces your brain to focus on one repetitive thing and to slow your breathing, which leads to a calmer nervous system and a more relaxed mind. It's basically a shortcut meditation and it can increase resilience to stress, decrease feelings of depression and increase positive feelings. You can do it almost anywhere - on the subway. in your car, at your desk. You can pair it with a literal box that you can see. If you're sitting at your desk, you can use your eyes to trace around your computer monitor while you do this and no one will notice. You can do this yourself and pretty quickly, to slow your breathing down, and then your brain will resume focus.

When I say this technique is simple, I want to clarify simple is not the same thing as easy. A plank is simple, right? You get down on the floor, put hands on the floor, and put your feet on the floor. A plank is not easy. By simple I mean the practice has one action or very few actions.

How do you encourage clients who say that they already know everything about breathing techniques? I pose the question back to the client and say, tell me what's working for you. Often, they may know what to do but they're not actually implementing it. Ask them questions; ask them to walk you through that sequence. Validation is important, but then get more information. Find out what hasn't worked, and bring it back to the client as the expert in their own self.  Validate their expertise and then find out how it's working in a noncombative, non-confrontational way. Sometimes you will hear a client say, "well I haven't done it in a while or maybe I rushed through it", and that's why it's not working for them.

Physical Grounding

I'm a big fan of forcing physiological changes, although force sounds like a strong word. When we start to feel panicked, it can lead to what is described as an out of body experience of feeling disconnected. This intensifies the panic, leading to flush cheeks and feelings of dizziness and warmth. You might find that you're describing yourself as feeling heavy, disconnected or out of body. By using an external source - like drinking a glass of really cold water, splashing your face with it or holding that cold glass in your hands -  you bring your body back to stasis. You're reminding your body that all of those panicky experiences are temporary and can be altered with intervention. Another physical grounding technique is sitting up straight in a chair, putting our feet on the ground, our hands on the armrest and our backs flush against the back of the chair, to remind our bodies that we are tethered to earth and that everything is tangible.

Focus on What You Can Control

Anxious feelings and panic often arise from feeling like we're out of control. We often then try to choose to control something we actually can't because we're not thinking clearly in those moments. In the early days of the pandemic, I would find myself spiraling into thoughts about the virus on a global scale, and feel despondent and hopeless about a vaccine ever being developed. I worried if I'd get to meet my niece or nephew, whether or not I'd get to see my parents again, whether or not I would get to have my wedding, and so forth. All of those thoughts give our brain something to do, but it's not the same thing as being productive.

The people who fared best focused on things that they could control, such as I can wash my hands and use sanitizer, I can wear a mask. I can go to the grocery store when it opens, I can creatively meal prep with what I have instead of going shopping again, I can think strategically about my space as it exists and use it to improve my situation. Drilling back down into what is within individual control was helpful for me and for a lot of other people.

Consistency/Routines

This is not a strategy that will go viral and be the latest TikTok sensation: Consistency and routines. Nobody likes to hear that we should go to bed and get up at the same time every day, but there's a reason routines are always recommended during times of struggle, The more consistent we can be, the more our brains can perform these routines on autopilot, which frees up our brain space to do other things that are more taxing. If you think of your brain like a computer, some programs will run in the background and some are actively working. When you have too many tabs open, what happens? Your computer overheats, processing is slow, and it shuts down. The same is true with your brain.

Hierarchy of Needs

Consider Maslow's hierarchy of needs. The basic needs at the bottom of the hierarchy are physiological: Food, shelter, sleep and clothing. Then comes safety, job security, medical care, and home safety. Next is love and belonging, friendship, and connection. Then we have esteem, mastery, achievement, recognition, and finally, self actualization. Self actualization is the pursuit of realization of a person's potential and self fulfillment; it is seeking personal growth and peak experiences. This level is the desire to accomplish everything that one can and to live up to one's fullest potential. When those bottom needs aren't met - food, shelter, sleep, clothing, safety, job, security, medical care, home safety - how could we possibly pursue higher needs? We often jump to fulfillment,  achievement and potential, and we don't recognize that we're not eating right, or our sleep is erratic. Basic needs must to be taken care of before we can move on to the higher level needs.

Wait 24 Hours

This is truly one of my favorite strategies for when I'm feeling in high conflict. It was taught to me as a child back when waiting meant writing a physical letter and putting it in a drawer before sending it. When we are in conflict or we sense that we're in danger, we enter a heightened state of arousal. This has protected our species for millennia.

That's why your hair stands up when you hear things that go bump in the night, it's why you pull your hands away from a hot stove or from a boss who's been criticizing you for the past 45 minutes. This built in alarm system is called the diffuse physiological arousal system. When your body is in diffuse physiological arousal or DPA, your heart speeds up, blood flows to your gut, your kidneys slow down, and adrenaline starts to pump. Ultimately you move into the fight, flight or freeze response. Think about any time you've fired off a response via email or text in the heat of the moment. Have you ever looked back and cringed at what you wrote once the adrenaline wore off? Practice writing your response in a draft that cannot be accidentally sent. For a text, put it in your notes app or for an email, put a whole new window with no recipient attached so that there is no danger of accidentally sending it. If after 24 hours, you still feel that way, go ahead and send it, but in my experience, I have never sent the first draft. I might take things out of it and say it differently, but I can't think of a time where I've went ahead and sent that first draft.

Positive Reframing 

Positive reframing is not toxic positivity. It's not pretending everything is fine when it isn't. It's also not about stopping yourself from experiencing negative or painful thoughts or emotions. Instead, it means evaluating whether or not you want to believe a thought. Based on your decision, you can decide to support yourself instead of constantly criticizing yourself. For example, rather than say "I hate my job. I hate my coworkers, I hate everything. I don't want to adult anymore", replace that with, "Things are tough right now and I'm feeling pretty disconnected from work. I wonder if I can change anything about my job, my situation, or my expectations and start to feel better." It doesn't take away from the fact that you hate your job, but it focuses on and what you can do within your control.

Gratitude Practice

This is something I love. I tried to do a gratitude practice a few years ago and I found that it was kind of a chore after a few weeks, and I was repeating things. When we express gratitude, we often do it generally such as "I'm grateful for my health." After a few days, this gets rote. Instead, I practice specific gratitude. Today I might say, "I'm grateful that I woke up today with clear lungs to open the window and breathe in the fresh spring air." Tomorrow, I may say, "I'm grateful that I woke up today with clear lungs so that I can go for a run." Gratitude for something specific keeps it fresh and novel. 

These are simple practices and you could do all of them in one day, or you could do one per day, whatever works for you. What I like about these strategies is that you don't have to remember complicated things. They don't ask our clients to do really complicated things. They are simple but they're not necessarily easy.

Separation and Boundaries

We talk about boundaries, but we sometimes forget how to set them. Let's review boundaries from a few different perspectives.

Creating Physical Space

If you're continuing to work from home or you're part of a hybrid model, think about how you may need to redesign your work environment to be optimally productive without burning out. Maybe you could set up room dividers, white noise machines, noise, blocking headphones, or even use peel and stick wallpaper. When I was in my old space, which was not conducive to work from home, I put a room divider in a corner of my bedroom so that when I was facing my computer, I couldn't see my bed. I put peel and stick wallpaper behind me so that it looked like an office when I was working with clients even though I was cramped in the corner of my bedroom. It worked for me while I was in that apartment. I moved because I had the opportunity to create a different physical space. 

Creating Emotional Space

Create emotional space with family or roommates. You can use timers and tell your children or family, when this timer goes off, you can come interrupt me, but not before then. You can also use nonverbal signals. I find a lot of success with colored sticky notes on the back of a laptop. A red sticky note might say, do not interrupt unless you're bleeding. A yellow sticky note might say, if it's really important, you can interrupt but I prefer that you didn't. Green says, I'm open to chatting, come interrupt me if you need. You don't have to stop what you're doing for someone to know which stage that you're in. With roommates or family it is sometimes helpful to have personal schedules. You may keep a shared Google calendar, similar to what is used that in an office setting. These solutions can be simple but really effective.

Creating Mental Space

Take breaks while you are working. I love the Pomodoro Technique, which is also called the tomato timer. This method involves working in set intervals separated by breaks, and you can vary the lengths to your preference. The way I do it is 25 minutes of work and five minutes of rest. Rest means getting up, walking away from my computer, stretching and taking the full five minutes without returning back to work. No matter if you're in the flow while working, you still stop at 25 minutes. And if you're done with your break after three minutes, you still go for five minutes. It's very effective. Build in yoga and stretching breaks. You can do Yoga with Adriene on YouTube or a 5- or 10-minute Peloton work out. You don't have to come up with your own routine - you can do a guided activity.  

Take PTO time off strategically to get the most out of it. Don't wait until you get to the point of you don't want to go to work today. Plan it out - think about scheduling a day off in the middle of a week to get things done so maybe you can feel less overwhelmed. 

Self-Care is Not Selfish

Self-care is not selfish. The message about self-care is that it's a reward for working ourselves to the bone, when actually self-care is mandatory for allied healthcare providers. We need self-care to ensure we don't do harm to others. When we give until we're empty and then try to give some more, we think we're being martyrs. If we are always available, always flexible with reschedules, always gracious when someone is late or a no show, it sounds like we're being caring, right? In actuality we are building exhaustion and resentment inside of ourselves.

How can we show up and be present attentive and empathetic and focused, if we're not taking care of ourselves? We could actually do permanent, irreparable harm. Balance is a word people use a lot, but they usually use it to imply perfection. Balance in yoga means the space between effort and ease. Think about your everyday life. You're never fully standing and equally distributing your weight on both legs, you lean on one side, on one leg. When that gets tired, you shift to the other leg. That's balance.

Work-life balance is not equally distributing your time everywhere. Sometimes work takes more. Sometimes home takes more, sometimes family takes more. Sometimes friends take more. Sometimes you take more from all of those areas and you don't have a lot to give. Balance is picking up the slack when the pendulum needs to swing in one direction for a while. The problem with the pandemic is that no one has the ability to give right now. As allied healthcare providers, we are often praised for how giving we are. The thing no one talks about is that we can do harm if we're trying to give from an empty vessel. My job as a therapist is to hold space, to observe and reflect, to validate and challenge and to actively listen. If I am stressed out, burned out and not nourishing myself, I can do actual harm with a thoughtless response.

We can't fix anyone's problems in one day, but if we're in a bad head space, we can exacerbate them and possibly do permanent damage. Taking care of ourselves has to be part of our ethical obligation. For that reason it has been added to the National Association of Social Workers Code of Ethics in 2021. The code was amended to include new language in the purpose section that says professional self-care is paramount for competent and ethical social work, practice, professional demands challenging workplace climates and exposure to trauma warrant that social workers maintain personal and professional health, safety and integrity. Social work organizations, agencies, and educational institutions are encouraged to promote organizational policies, practices, and materials to support social worker's self-care.

Creating Separation and Setting Boundaries - Example

To create separation and set boundaries:

• Take the onus on
• Align and join together
• Explain clearly and without apology
• Validate

To create separation and set boundaries, first I take the onus on. Then, I align myself with the client who's asking me for more than I can give. I align and join together with them using a lot of "we" language. I explain clearly, but without apology. And, I validate.

Here's my standard response when clients text me at a time that's outside of business hours, or email me to share something that's personal. I have younger clients who might share a video with me, which is very sweet, but is not what our relationship should be.

I take the onus on, and explain that I want to clarify why our policies are the way they are because I think transparency is important. I say that the reason I have specific hours and modes of communication is that I would hate it if on a Friday night they had an expectation that I would be available to respond and they contacted me expecting a response. Maybe I would be out to dinner with my family and possibly had a glass of wine at dinner. I'm aligning and joining with the client by saying I would hate that for you. I tell them that I would then have to choose between answering them, which would be unethical and not in their best interest, or ignoring them, which would make them feel rejected. I explain without apologizing.  I say that it works best for everyone to know when and how to communicate so that I can be fully present for our work together, which is validation. As a practitioner in private practice, I am often seen as being available all the time so this is the boundary that I have established.

Questions and Answers

Do you have any suggestions for working back from the place of burnout?

That's one thing that I didn't have time to cover, which is what if you're already burned out? That's tough and I'm not going to pretend that we can just say, "Do this and you'll feel great". I think it starts with zooming out and taking the 30,000 foot view of your life. Break it down into domains, such as family, personal, professional, friends, health, etc. Start listing out all the ways in which you would like to live. Ask yourself what would it look like if you were actually doing those things. For example with health, I would love to work out five days a week, but let's be realistic. Is that really what you want that would make you feel best? Maybe it's three days a week for 45 minutes. Block out that time.

Make adjustments and then ask what would it look like for you to say to your family, I need 45 minutes (or maybe an hour so you can build in some buffers) three times a week. Often we don't set boundaries because we are afraid of the answer. We're afraid that the people that we love won't show that they love us enough back by doing the thing that we've asked. Then we're not telling people how to show up for us. I hear this all the time from my younger clients who are dating. They say, "I can't say that to them because then they'll break up with me". Then we have the conversation of whether they want to be with someone who can't respect their boundaries or can't listen to them.

You may do a lot for other people maybe out of a sense of obligation or because you think it's what you are supposed to do. And maybe that actually isn't the best answer for everyone involved. You may think about stepping back from a project at work, but find a solution for who can take it on. Maybe you can delegate and support a junior person in learning how to take the project and run with it. Unfortunately, coming back from burnout is specific to each individual but in general it will involve looking at the big picture and determining where you are giving without receiving reciprocity and figuring out where you can find support. Boundaries are not about rejecting people and saying "stay out".  Rather, boundaries are an invitation of where you can meet and work together.  

My contact information is in the slides and I'm always happy to talk with other practitioners if you want to have further conversations. 

References

A complete list of references is available in the course handout.